|The typical protein levels of the Atkins diet are not ketogenic in our research mice and in fact promotes obesity in them. The Atkins diet is not really ketogenic, at least in mice.|
– Dr. Charles Mobbs
Ketogenic diets are certainly nothing new in nutrition, and we have the late, great Dr. Robert C. Atkins to thank for that. He played an integral part in the marketing of a low-carb, high-fat nutritional approach for burning fat and generating ketones. When Dr. Atkins first began promoting ketosis in the early 1970s, the methods for measuring for ketones were quite primitive. But thanks to some new technology that has come along in recent years, we can quantify ketone production to make sure you’re at a level that will give you the benefits that ketogenic diets promise.
If you’ve ever followed an Atkins-style low-carb diet, you probably already understand the importance of being in a ketogenic state, in which your body switches from using carbohydrates as a primary fuel source to using fat—both dietary and stored body fat—and ketone bodies. Dr. Atkins was far ahead of his time when he made this key concept the centerpiece of his bestselling books. Despite their popularity, however, the “k” word quickly became taboo because of the confusion between it and diabetic ketoacidosis (as discussed in chapter 1). As much as Dr. Atkins tried to explain that ketosis is something different, the negative stigma stuck. That’s why the marketing for the Atkins diet has always focused more on carbohydrate restriction and less on ketosis.
There was no formal specific ratio of macronutrients we designed for each patient. Dr. Atkins knew what constituted 20 grams of carbs and the order in which he wanted to advance the plan. We watched changes in both breath and urine ketones as well as control of hunger and cravings as we advanced the carb intake. Of course, improvement in lab values and presenting symptoms were also important markers of a healthier metabolism.
– Jackie Eberstein
This is one reason I believe the phrase “nutritional ketosis” is a much better way of framing the idea of becoming keto-adapted or fat-adapted through the use of a well-formulated high-fat, moderate-protein, low-carb diet—it helps us move away from fears of diabetic ketoacidosis and focus more on how we can control ketosis through nutrition.
The term “nutritional ketosis” has become popular in the low-carb community in recent years thanks to a series of books written by low-carb researchers Dr. Stephen Phinney and Dr. Jeff Volek. They first used the phrase in their 2010 New York Times bestselling book The New Atkins for a New You (written with the coauthor of this book, Dr. Eric Westman).
Phinney and Volek continued to use and define the term in their subsequent books The Art and Science of Low Carbohydrate Living and The Art and Science of Low Carbohydrate Performance. This branding of nutritional ketosis has been the best addition to the low-carb vernacular since we stopped talking about a “low-carb diet” and started talking about a “low-carb lifestyle.”
Additionally, although Dr. Atkins talked about ketosis and the role it plays in improving health, he didn’t communicate any concrete, practical advice for getting there. There are plenty of benefits to your health that come from being in a state of ketosis, so this understanding is crucial to grasp.
To truly get the health benefits of nutritional ketosis, you need to find the macronutrient mix that is right for you (which is what chapters 5 through 7 are all about). We owe a great deal of gratitude to Dr. Atkins for making us aware of the benefits of ketosis. Now we stand on his shoulders by taking that work to the next level and helping people figure out what it takes to produce ketones at the level where they can see the most benefit. A ketogenic diet isn’t the same for everyone because we all have varying levels of carbohydrate tolerance, and that tolerance needs to be part of the equation, as you’ll soon learn.
The underlying formula is for the most part the same: omit sources of dietary sugar and starch, moderate protein intake to no more than 2 to 3 ounces per meal, and then consume as much dietary fat from a variety of natural sources as desired or required to meet essential fatty acid needs and basic satiety. I also allow for the liberal consumption of fibrous vegetables and greens as a means of providing helpful phytonutrients and antioxidants. These may be consumed raw, cooked, cultured or fermented, or in the form of raw, unsweetened juice. Again, all this needs to be customized to a person’s particular needs and tolerances, with careful monitoring of blood ketone levels for continued effectiveness.
– Nora Gedgaudas
So what are the biggest differences between a truly ketogenic diet and the low-carb, high-fat diet that Dr. Atkins made popular? It’s a subtle but very important distinction.
Nutritional ketosis, in which the body burns fat to generate ketones for energy, can only be brought on by a low-carb, moderate-protein, high-fat diet. An Atkins-style low-carb diet may or may not meet those requirements, since its focus tends to be more on restricting carbohydrates as the primary function. The only way to tell if an Atkins diet is inducing ketosis is by checking for ketones, and the gold standard is to measure ketones in the blood.
Traditionally, however, ketosis has been measured with urine testing strips. These strips turn pink or purple in the presence of ketones (specifically, acetoacetate, the ketone body found in urine). But in their book The Art and Science of Low Carbohydrate Performance, Phinney and Volek recommend measuring blood ketones (beta-hydroxybutyrate) as a better and more reliable way of gauging ketone levels, allowing you to aim for the optimal range of 0.5 to 3.0 millimolar. We will go into great detail about all of this in chapter 8, but for now, just know that the technological advances in testing are one of the things that has made it possible to determine with greater accuracy if someone on an Atkins diet is in nutritional ketosis.
You won’t know if you are in ketosis without checking beta-hydroxybutyrate levels. Until blood ketones are high enough, even more fine-tuning will be required. Over time, once ketosis is achieved, it is not necessary to measure all the time unless changes in diet or other stressors like exercise and travel occur.
–Dr. Zeeshan Arain
While it’s not necessary to do any testing at all to experience the benefits of ketosis, you really are just guessing if you don’t. Eating low-carb is certainly an important first step, but it’s not the only thing you need to do to make your diet truly ketogenic. We’re going to dive headfirst into that with more details in a few chapters, but first we’ll see what major health organizations have to say about ketosis in the next chapter. As you can imagine, they have fallen prey to the massive amount of misinformation out there confusing nutritional ketosis with ketoacidosis.
I am not aware of any serious adverse effects of long-term nutritional ketosis.
– Dr. Jay Wortman
Key Keto Clarity Concepts
- Ketogenic diets were first popularized by the late, great Dr. Robert C. Atkins.
- The low-carb Atkins diet is subtly different from a ketogenic diet.
- Changing the language we use to describe ketosis can assuage fears about it.
- The Atkins diet never offered practical ways to increase ketone production.
- What it takes to get into ketosis varies greatly from person to person.
- An Atkins-style low-carb diet may or may not generate adequate ketones.
- Without measuring ketone levels, eating low-carb, high-fat is a guessing game.